Medical Claims Review Manager jobs in Ohio
Medical Claims Review Manager oversees the performance, productivity, and quality of the medical claims review staff. Responsible for hiring, training, and firing medical claims review staff. Being a Medical Claims Review Manager evaluates medical claims review processes and recommends process improvements. Serves as a technical resource for all medical review workers. Additionally, Medical Claims Review Manager typically requires an RN or BSN. Requires a bachelor's degree. Typically reports to a head of a unit/department. The Medical Claims Review Manager manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. Extensive knowledge of department processes. To be a Medical Claims Review Manager typically requires 5 years experience in the related area as an individual contributor. 1 to 3 years supervisory experience may be required. (Copyright 2024 Salary.com)
Recently Added Medical Claims Review Manager jobs
Claims Manager
- AIG Claims, Inc.
-
Remote, OH
FULL_TIME
- This is a hybrid role in Cincinnati Ohio requiring 3 to 4 days in office. Who we are American International Group, Inc. (AIG) is a leading global insurance organization. AIG member companies provide a wide range of property casualty insurance in approximately 70 countries and jurisdictions. These diverse offerings include products and services that help businesses and individuals protect their assets and manage risks. We’re also committed to making a positive difference for our colleagues and in the communities where we work and live. We encourage colleagues to give back to the causes they care most about, supporting these efforts through our Volunteer Time Off and Matching Grants Programs. Get to know the business General Insurance is a leading provider of insurance products and services for commercial and personal insurance customers. It includes one of the world’s most far-reaching property casualty networks. General Insurance offers a broad range of products to customers through a diversified, multichannel distribution network. Our Claims professionals support AIG policyholders through some of the most trying times. When our clients face losses large and small, we step up to help them ease the financial burdens of catastrophic events like fires and hurricanes; we help them get their businesses back up and running again or recoup the value of a lost family heirloom or a prized possession. Our Claims team is an industry leader, drawing daily on its unparalleled levels of expertise to offer our clients the highest levels of stewardship to drive total cost of claim improvement and consistent outcomes. AIG manages claims using a wealth of technical and market knowledge about risks, business practices, and the ever-evolving legal and regulatory environment. About the role The Claims Intake Department (CID) receives the First Notices of Loss (FNOL) and sets up Excess and Environmental Specialty Claim (ESC) claim files, as well as triaging or monitoring Notice Only Excess claim files. The claim files created in CID are for Excess Construction Defect, Mass Tort, Healthcare, ESC/Pollution, Workers Comp., General Liability, Coverage and Punitive Wrap (PW), etc. The claim files and Punitive Wrap claim files are initially assigned to CID technicians who do first party investigations to evaluate the exposure and to determine if the claim files should be opened and assigned to an adjuster (Excess Analyst) or segmented as a Notice Only for continued monitoring within CID. To varying degrees, CID’s handling of FNOL’s lays the foundation for early recognition of exposures which impacts the financial results of the company. What you need to know As a CID Manager, you will be responsible for managing a staff of Claim Intake Assistants, Segmentation Technicians and Segmentation Specialist as well as reviewing and assigning the daily new claims to the CID technicians and supporting the Frist Notice of Loss and claim creation process in CID. The position requires proven leadership skills in managing and training a staff with no prior insurance experience and to develop the staff into AIG’s next generation of claims adjusters, underwriters, operations specialist, etc. You must have a strong knowledge of the legal and claims process, as well as the different jurisdiction/venue constraints/impacts, and be able to build strong networks with the different claims units, underwriting, IT and external stakeholders and have a proven track record of delivering outstanding results. Provide weekly or frequency updates of incoming volume Maintain trial and mediation log Serve as liaison with Shared Service/Accenture for case creates Manage the Segmentation Specialists who will assist with the handling of the Punitive Wrap (PW) files Manage a pending of Excess and PW files Assign on-going active noticed only files to the Segmentation Specialists based on referral from the managers Provide feedback on goals and objectives Closely follow departmental guidelines and industry knowledge to ensure that the case is established for the correct line of business, and ensure data entry accuracy, including loss types, proper major class code selection, trend codes, etc. Train and support the Segmentation Technicians with the management and investigation of their claim files What we're looking for Proven ability to work with tight timelines when necessary Advanced working knowledge in investigating General insurance claims An understanding of local customs, insurance markets and a strong knowledge of fraud and recovery legislation is desired Commitment to data and analytics including an ability to analyze complex data sets to assess trends and identify opportunities to drive improved results An excellent communicator with a strong collaborative mindset Ability to leverage technology and analytics to achieve goals 8 years of relevant experience in claims and/or an insurance company Looking for a self-motivated Leader to lead a diverse team Knowledge of reinsurance including underwriting, claims, accounting, finance and associated process, controls and systems. Strong technical skills in Microsoft Excel, Power Point and Word (Access a plus). #LI-CY1 Enjoy benefits that take care of what matters At AIG, our people are our greatest asset. We know how important it is to protect and invest in what’s most important to you. That is why we created our Total Rewards Program, a comprehensive benefits package that extends beyond time spent at work to offer benefits focused on your health, wellbeing and financial security—as well as your professional development—to bring peace of mind to you and your family. Reimagining insurance to make a bigger difference to the world American International Group, Inc. (AIG) is a global leader in commercial and personal insurance solutions; we are one of the world’s most far-reaching property casualty networks. It is an exciting time to join us — across our operations, we are thinking in new and innovative ways to deliver ever-better solutions to our customers. At AIG, you can go further to support individuals, businesses, and communities, helping them to manage risk, respond to times of uncertainty and discover new potential. We invest in our largest asset, our people, through continuous learning and development, in a culture that celebrates everyone for who they are and what they want to become. Welcome to a culture of belonging We’re committed to creating a culture that truly respects and celebrates each other’s talents, backgrounds, cultures, opinions and goals. We foster a culture of inclusion and belonging through our flexible work arrangements, diversity and inclusion learning, cultural awareness activities and Employee Resource Groups (ERGs). With global chapters, ERGs are a cornerstone for our culture of inclusion. The diversity of our people is one of AIG’s greatest assets, and we are honored that our drive for positive change has been recognized by numerous recent awards and accreditations. AIG provides equal opportunity to all qualified individuals regardless of race, color, religion, age, gender, gender expression, national origin, veteran status, disability or any other legally protected categories. AIG is committed to working with and providing reasonable accommodations to job applicants and employees with disabilities. If you believe you need a reasonable accommodation, please send an email to candidatecare@aig.com. Functional Area: CL - Claims Estimated Travel Percentage (%): Relocation Provided: AIG Claims, Inc. At AIG, helping people discover new potential is our purpose. As a global risk leader, we do this for our clients every day. Through our deep expertise in their industries and our innovative solutions that help them smartly manage risk, we enable their growth in ways they never thought possible. But we also do the same thing for our employees, because we know our people are our greatest strength-the source of every insight, every idea and every innovation. When we're working as one team to do what's right for our colleagues and our communities, we can achieve excellence together. We encourage colleagues to give back to the causes they care most about, supporting these efforts through our Volunteer Time Off and Matching Grants Programs. Join our Talent Network . Additional information about AIG can be found at www.aig.com | YouTube | Twitter | LinkedIn.
- 4 Days Ago
RN Medical Claims Review Nurse (Remote)
- Morgan Stephens
-
Columbus, OH
FULL_TIME
- Medical Claims Review Nurse Position is fully remote Schedule: M-F 9AM-5PM local time. The training schedule will be M-F 9AM-5PM EST. Daily responsibilities: Candidates will be reviewing medical patie...
- 2 Months Ago
Claims Review Specialist
- Sheakley Group, Inc
-
UNKNOWN, OH
FULL_TIME
- Job Summary The Claim Review Specialist is responsible for entering and processing initial claims and completing preliminary calls to employer, provider, injured worker and Bureau of Workers Compensat...
- 18 Days Ago
Medical Records Review Coordinator
- BizTek People, Inc. | APA International Placement Consultants
-
Maumee, OH
FULL_TIME
- Title: Medical Records Review CoordinatorDuration: 12 WeeksLocation: Maumee, OH JOB DESCRIPTIONPerforms audits of medical records from primary care and specialty provider offices to collect medical fa...
- 4 Days Ago
Utilization Review Nurse - Utilization Management
- METROHEALTH MEDICAL CENTER
-
Cleveland, OH
FULL_TIME
- Location: METROHEALTH MEDICAL CENTER Biweekly Hours: 64.00 Shift: variable start time, day shift The MetroHealth System is redefining health care by going beyond medical treatment to improve the found...
- 5 Days Ago
Registered Nurse - Peer Review Specialist
- METROHEALTH MEDICAL CENTER
-
Cleveland, OH
FULL_TIME
- Location: METROHEALTH MEDICAL CENTER Biweekly Hours: 40.00 Shift: 8-5 The MetroHealth System is redefining health care by going beyond medical treatment to improve the foundations of community health ...
- 21 Days Ago
Medical Claims Review Manager jobs at Popular Companies
Hospital Medical Leader
- Petco
-
Fairfield, CA
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Hospital Medical Leader
- Petco
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Hospital Medical Leader
- Petco Animal Supplies Inc
-
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Head of Medical Writing
- Barrington James
-
- Clinical-stage biopharmaceutical company in San Francisco, is seeking a Head of Medical Writing. This leadership role in...
- 6/8/2024 12:00:00 AM
Head of Medical Strategy
- ExecuSearch
-
Atlanta, GA
- The Head of Medical Strategy provides medical expertise to the rheumatology commercial and medical teams and provides cl...
- 6/8/2024 12:00:00 AM
Head of Medical Strategy Rheumatology
- UCB
-
Atlanta, GA
- Make your mark for patients The Head of Medical Strategy provides medical expertise to the rheumatology commercial and m...
- 6/8/2024 12:00:00 AM
Head of Medical Writing
- Barrington James
-
San Francisco, CA
- Head of Medical Writing - Rare disease Biotech We are currently partnered with a growing, west coast based biotech focus...
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Hospital Medical Leader
- Petco Animal Supplies, Inc.
-
Plainview, NY
- Create a healthier, brighter future for pets, pet parents and people! If you want to make a real difference, create an e...
- 6/7/2024 12:00:00 AM
About Ohio
Ohio /oʊˈhaɪoʊ/ (listen) is a Midwestern state in the Great Lakes region of the United States. Of the fifty states, it is the 34th largest by area, the seventh most populous, and the tenth most densely populated. The state's capital and largest city is Columbus.
The state takes its name from the Ohio River, whose name in turn originated from the Seneca word ohiːyo', meaning "good river", "great river" or "large creek". Partitioned from the Northwest Territory, Ohio was the 17th state admitted to the Union on March 1, 1803, and the first under the Northwest Ordinance. Ohio is historically know...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Claims Review Manager jobs
$95,867 to $122,233
Most Popular Cities in Ohio for Medical Claims Review Manager Jobs
What does a Medical Claims Review Manager do?
Medical Claims Review Manager in Parkersburg, WV
This end-to-end e-billing and e-payment solution is fully integrated with DecisionPoint, which means it can be immediately and easily integrated with your providers, adjusters, IT infrastructure, and claims workflow—enabling you to.
January 01, 2020
Medical Claims Review Manager in Juneau, AK
Examples include a claims examiners view of a particular bills status in a claim records related bill screen, or a bill review analysts view of an available reserve amount for the claim record related to the bill they are processing.
December 03, 2019
Medical Claims Review Manager in Galveston, TX
Assists the Manager, Medical Review with performing duties to oversee day-to-day activities within the Medical Claims Review Department to facilitate the achievement of business goals and targets.
December 16, 2019